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PEER-TO-PEER CLINICAL CONVERSATIONS
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Non-Surgical Management of Non-Muscle Invasive Bladder Cancer: Surveillance, Chemoablation, and Office-Based Approaches
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Katie Murray, DO, MS, FACS
Katie Murray discusses non-surgical management options for non-muscle invasive bladder cancer, covering the patient populations where TURBT can be deferred. She identifies recurrent low-grade disease with a documented history as the clearest candidate for surveillance, office fulguration, or chemoablation with UGN-102, particularly in elderly or high-comorbidity patients
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Rethinking Recurrence Burden in Low-Grade and Intermediate-Risk NMIBC
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Sarah Psutka, MD, MS, FACS
Sarah Psutka discusses the often-underrecognized burden of recurrent low-grade and intermediate-risk NMIBC, including the cumulative impact of repeated cystoscopy, TURBT, anesthesia exposure, treatment cycles, and disease-related anxiety. She highlights the need for more risk-adapted approaches, including active surveillance, office-based management, and individualized treatment decisions that better align disease biology with patient quality of life.
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Cystoscopy vs Urinary Markers: A Debate on Bladder Cancer Surveillance Strategies
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Jeremy Teoh, MBBS, FRCSEd (Urol), FCSHK, FHKAM, and Laura Mertens, MD, PhD
Ashish Kamat moderates a debate between Jeremy Teoh and Laura Mertens on cystoscopy versus urinary markers for NMIBC surveillance. Teoh cites the DaBlaCa-15 and UroFollow non-inferiority trials supporting marker-based surveillance as a way to reduce cystoscopy frequency in low- to intermediate-risk disease, where progression risk is approximately 1% per year.
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| Treatment with UGN-102 in Patients with Recurrent Low-Grade Intermediate Risk Non-Muscle Invasive Bladder Cancer: 24-Month Duration of Response Data from the Phase 3 ENVISION Trial
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| Mark Schoenberg, MD
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| UGN-102 produced a robust 3-month complete response rate of 79.6% in recurrent low-grade intermediate-risk NMIBC, and among those responders, 82.4% remained in response at 12 months and 72.2% at 24 months. These data support UGN-102 as a durable, well-tolerated nonsurgical option, although the single-arm design means the results should be interpreted cautiously.
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| REL-NDV01-301 (BOOST) - A Phase 3, Randomized Study of Adjuvant Intravesical Sustained-Release Gemcitabine-Docetaxel (NDV-01) Versus Surveillance for the Treatment of Intermediate-Risk NMIBC
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| Max Kates, MD
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| Max Kates presented the trial in progress: REL-NDV01-301 (BOOST) - A Phase 3, Randomized Study of Adjuvant Intravesical Sustained-Release Gemcitabine-Docetaxel (NDV-01) Versus Surveillance for the Treatment of Intermediate-Risk Non-Muscle Invasive Bladder Cancer. The trial was designed with 90% statistical power using a one-sided alpha of 0.025 to detect a significant difference between treatment groups.
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| Clinical Validation of the International Bladder Cancer Group's Intermediate-risk Non-muscle-invasive Bladder cancer Stratification Model
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| Jayant Siva, MD
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| The largest validation study of the International Bladder Cancer Group’s intermediate-risk NMIBC model showed it cleanly separates patients into three prognostic groups. At 3 years, recurrence rose from 16% in IR-low to 48% in IR-intermediate and 95% in IR-high, while progression increased from 3% to 9% to 30%, supporting routine use of the model for risk stratification and treatment planning.
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| Patient Time Toxicity from Management Options for NMIBC
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| Veerain Gupta, MD
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| Among Medicare beneficiaries with NMIBC, patient time toxicity was highest with cystectomy, followed by intravesical chemotherapy and then BCG, compared with TURBT alone. In this SEER-Medicare analysis of 32,934 patients, median healthcare contact days were 15 with TURBT alone, 17 with BCG, 19 with intravesical chemotherapy, and 34 with cystectomy, highlighting the added indirect burden of more intensive treatments.
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